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SBM block 2 > Everything Else > Flashcards

Everything Else Flashcards

1
Q

What is a problem with DSM 4 classification?

A

Assumption that each disorder is separate

Often we see comorbidity

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2
Q

What is the goal of DSM 5?

A

Prognosis based on individual rather than testing

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3
Q

What are some criticisms of DSM-5?

A
  • lacks transparency
  • conflict of interest
  • ## lack of outside input
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4
Q

What is the Bereavement exclusion?

A

No exclusion of diagnosis for 2 months

- now you can diagnosis something directly after a situation occurs (like depression after a loved ones death)

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5
Q

For something to be diagnosed what criteria must be met?

A
  • symptoms - patterns of cognition and behavior subjectively reported
  • signs - patterns of cognition and behavior objectively observed
  • timing - symptoms and signs present at a certain frequency
  • impairment - in two or more realms
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6
Q

How many major diagnostic classes are in the DSM-5?

A

19

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7
Q

What is body integrity disorder?

A

Wanting healthy limbs cut off because “it feels right”

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8
Q

What is the official coding system?

A

Not DSM 5

- international classification of diseases, clinical manifestation (ICD-9-CM)

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9
Q

When must ADHD be presented?

A
  • Before age 12
  • 2 or more settings - academic, social, family
  • 3-5% of school aged children have ADHD
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10
Q

What are the two types of ADHD?

A
  • inattentive: focus and organize

- hyperactive/impulsive: loud and interruptive

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11
Q

Where does inattentive ADHD present most?

A

In girls

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12
Q

What are things that cause ADHD?

A

Genetics, in utero exposure (nicotine, alcohol, cannibis), notochord trauma, frontal lobe trauma (heavy metal exposure),

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13
Q

What are some comorbidities of ADHD?

A 
Learning disabilities 
ODD
Anxiety disorders
Mood disorders
Psychotic
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14
Q

What can TICS be confused for?

A

ADHD

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15
Q

What is a function problem in ADHD?

A

The executive function is significantly lower than IQ

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16
Q

What are some things you rule out before diagnosing ADHD?

A
  • Neuro seizures
  • Tourette’s
  • migraines
  • endocrine
  • diabetes
  • drugs
  • sleep disorders
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17
Q

What may “i can’t play video games all day long” indicate?

A

ODD or learning disorder

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18
Q

What may “video games are boring” indicate?

A

ADHD

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19
Q

What are some tests for ADHD?

A

Wisconsin card sorting test

- working memory and processing speed

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20
Q

What is cloninger “dimensions?”

A

It describes personality

  • increased risk taking
  • decreased harm avoidance
  • reward dependance
  • only ADHD
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21
Q

What are the stages of ADHD treatment?

A
  • Stage 0: adjunctive - special ed if with learning disabilities. Parent education. Behavior modifications. Individual therapy.
  • Stage 1: methylphenidate (Ritalin) or amphetamine
  • stage 2: Ritalin, adderall, focalin (continuous-concerta)
  • stage 3: atomoxetine
  • stage 4: atomoxetine plus stim
  • stage 5: TCAs
  • stage 6: alpha agonist (2) BP meds to calm - little focus
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22
Q

What are two last stage ADHD meds?

A

Alpha agonists

Clonidine
Gaunfacine

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23
Q

What drug can cure both ADHD and anxiety?

A

Atomoxetine

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24
Q

How do you treat ADHD with tic disorders?

A

1: stim mono therapy
2: stim and alpha agonists
3: add atypical antipsychotic
4: add pimozide or haloperidol

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25
Q

How do you treat ADHD with aggression?

A 
ADHD 
Stim
Atypical stim
Lithium or divalproex
Add both
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26
Q

How do you treat ADHD with chemical dependency?

A
  • chemical dependancy
  • strattera vs bupropion
  • treatment with urine testing
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27
Q

What are the most common comorbidities of PTSD?

A
  • ODD
  • depression
  • anxiety
  • substance abuse disorder
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28
Q

What is reactive attachment disorder?

A
  • emotionally withdrawn behavior toward adult caregivers
  • a persistent social and emotional disturbance
  • child has experienced a pattern of extremes of insufficient care
  • event before age 5 at least 9 months
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29
Q

What is disinhibited social engagement disorder?

A
  • overly familiar behavior with relative strangers

- childhood disorders

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30
Q

What is ASD?

A

Acute stress disorder

  • pre PTSD
  • 3days- 1 month
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31
Q

What is criteria A for PTSD?

A

How the event is experienced

  • directly experiencing
  • witnessing in person
  • learning an event happened to someone close
  • repeated exposure to aversive details (1st respon)
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32
Q

What are the four symptoms of PTSD? (Criteria B-E)

A

B: intrusive symptom (dreams, flashbacks)
C: avoidance of reminders
D: neg alterations in cognition and mood (depress)
E: alterations of arousal and reactivity (hyper vigilance, sleep probs)

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33
Q

What is criteria F of PTSD?

A

Duration

Must persist at least a month

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34
Q

What is criteria G of PTSD?

A

Distress - in social and occupational life

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35
Q

What are the specifies for PTSD?

A

Acute - within 3 months of event

Chronic - after 3 months

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36
Q

What are the criteria for PTSD?

A 
A: how it is experienced 
B: intrusive symptoms
C: avoidance
D: neg alterations in cog and mood
E: alterations in arousal and reactivity
F: duration
G: distress (social and job)
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37
Q

What is the major change in the DSM-5 for PTSD?

A

Sexual assault is specifically included (also recurring exposure like first responders)

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38
Q

What is the evaluation of PTSD?

A 
15-1hr if needed for legal claims
- use DREAMS
D: detachment
R: re experiencing event
E: emotional effects
A: avoidance
M: month of duration 
S: sympathetic hyperactivity of vigilance
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39
Q

What is the biological basis for PTSD?

A

NE: fear, flight response, sympathetic activation, arousal, hyperactvity, (too much)
5HT: self defense, rage and attenuation of fear
(Too little): aggression, violence, depression, anxiety, impulsive

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40
Q

What is the lifetime prevalence of PTSD?

A

7.8% up to 12%

10.4% for women
5% for men

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41
Q

What is the PTSD risk by event?

A

Rape-49
Severe beating/assault-31.9
Other sexual assault-23.7

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42
Q

What is the prevalence by gender of PTSD?

A

Men: rape, combat, childhood neglect, childhood abuse
Women: rape, sexual molestation,physical attack, weapon, childhood physical abuse

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43
Q

What are some risk factors for ptsd?

A

Women: anxiety and depression,
Men: irritability, impulsiveness, substance abuse
African Americans and Hispanic war vets

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44
Q

What is the comorbidity of PTSD?

A

80%

  • anxiety
  • affective (MDD, bipolar)
  • depression and mania are more likely to occur
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45
Q

What is the rate of suicide for PTSD Pxs?

A

20%

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46
Q

What are the three types of stress injuries in PTSD?

A
  • traumatic stress is due to horror or terror
  • operational fatigue is due to accumulation of stresses over time
  • grief is due to loss of important friends or leaders
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47
Q

What is the trauma transmission model?

A

Partners use sympathy and empathy

Results in realistic experience

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48
Q

What percent of partners of military members with PTSD have significantly higher clinical levels of relational distress?

A

71% compared to 36% without a partner with PTSD

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49
Q

What are the two types of therapies for PTSD?

A

Exposure: education to common rxns to trauma, repeated exposure to past trauma
Cognitive: separating the intrusive thoughts from associated stress and anxiety
Also stress inoculation - variant of exposure training

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50
Q

What medications do you use to treat PTSD?

A

SSRIs and TCA

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51
Q

What percent of soldiers need mental health assessment and get care?

A

33% need it
Only 12.5% get it
More likely to contact a medical professional

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52
Q

What is the difference between the percentage of PTSD Pxs who go to their behavioral health specialist?

A

44% go if reffered

76% go when introduced

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53
Q

What is the symptom experience of PTSD and when should he have therapy?

A
  • on and off symptoms

- therapy 1 month or sooner and then every 3 months

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54
Q

What is a problem with professional training with relation to PTSD?

A

They aren’t trained to assess for psychosocial difficulties

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55
Q

What is the assessment tool used to assess neuro development?

A

Ages and stages questionnaire (ASQ-3)

Completed by parents in 10-15min

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56
Q

How do you diagnosis a neuro developmental disorder?

A
  • individualized intelligence testing (score below or at 70 +- 5)
  • multiple low function in normal life
  • onset of intellectual and adaptive deficits
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57
Q

What are the adaptive functioning severity domains?

A

Conceptual - symbolic thought, reasoning, problems
Social - awareness of others, empathy, communication and friendship skills
Practical - learning and self-management skills

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58
Q

What is the overall general prevalence of intellectual disability?

A

1%

6 in 1000 for severe

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59
Q

What is the gender ratio of ASD?

A

4:1

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60
Q

What is the prevalence of ASD?

A

1%

1 out of 68 people in the U.S.

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61
Q

What are the diagnostic criteria for ASD?

A
  • persistent deficits in social communication and interactions
  • restricted repetitive patterns of behavior, interests, and activities manifested by at least 2 of the following: repetitive motor movements, insistence and sameness, fixated interests, hypo or hyper reactivity to sensory input
  • early development
  • clinically sig impairment in areas
  • disturbances are not better explained by intellectual disability
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62
Q

What is the treatment of ASD?

A
  • behavioral treatment and management (ABA)
  • specialized therapies
  • child and family therapy: social play, and to support family
  • meds: according to conditions and behaviors
  • local community resources
  • web
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63
Q

What is Yerke’s Dodson anxiety-performance curve?

A

A curve showing the spectrum of anxiety disorder

psychotic symptoms can be normal

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64
Q

What is the hallmark of panic disorder?

A

Fight-or-Flight response

Feel they are losing control

Can feel like an MI

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65
Q

What is the epidemiology of panic disorder?

A

1.5% lifetime prevalence
4:1 women:men
Late teens - early 30s
3.5% general pop
6-10% primary care
30-50% cardiology

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66
Q

What is the epidemiology of social anxiety disorder?

A

3-13%
16 years
20% report fear of public speaking

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67
Q

What are the most common obsessions of OCD?

A

Contamination and violent images

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68
Q

What are features of compulsions seen in OCD?

A

Ritualized behaviors to alleviate obsessions

  • recurrent
  • Px recognizes these are unreasonable
69
Q

What is the prevalence of OCD?

A

Lifetime: 2-3%

One year: 1.5-2.1%

70
Q

What are comorbidities of OCD?

A

Depression and panic disorders

71
Q

What is the little Albert experiment?

A

Loud noise conditioned to other things

72
Q

What is the behavioral model of anxiety?

A

Two factor learning theory

  • neutral and anxiety stimulus paired
  • avoidance of neutral seems good
  • associative learning
73
Q

What is the behavioral model of OCD?

A

Obsession: pairing mental stim with anxiety provoking thoughts
Compulsion: neutral behaviors to relieve obsessions
Cycle: obsessions–>anxiety–>cumpulsion–>relief–>repeat

74
Q

What is the cognitive model of panic?

A

Trigger–> perceived threat–> apprehension –> body sensations –> interpretation of sensations as catastrophic

75
Q

What are factors of OCD?

A

Concordance in identical twins is 75%

32% in non

76
Q

What neuro chemistry disorder is a risk factor for anxiety?

A

GABA dysfunction
Activation will help (benzos)
Blocking increases panicogenic effect (caffiene)

77
Q

What is wrong with 5HT in OCD?

A 
Too little (mostly stim)
High rates of metabolism in CSF
78
Q

What does CRH have to do with anxiety?

A

Central stress signature

Hypothalamus

79
Q

What does adenosine have to do with anxiety?

A

Receptors are anxiolytic similar to GABA
Relief of stress
Blocking can induce panic

80
Q

What other things are anxiolytic?

A

Neuropeptide Y and endogenous opioids

81
Q

What do lactate and co2 do?

A

Can increase anxiety

82
Q

What is TKS mostly concerned with?

A

Px is concerned about doing something, or presenting an appearance, that will offend or embarrass the other person, compared to oneself as in SAD

Males:females - 3:2

83
Q

What are the four types of kyofu in TKS?

A

Fear of blushing
Of a deformed body
Or eye-to-eye contact
Of ones own foul body Oder

84
Q

What are some concerns in the LBGTQ community?

A

Major depression
GAD
Substance abuse or dependance

Men- panic attacks
Women- GAD

85
Q

What percent of rape victims experience depression?

A

30%

  • Compared to a normal 10%
  • 33% of rape victims have serious thoughts of killing themselves as opposed to 8% normal
  • 13X more likely to commit suicide
  • 13.4X more to alcohol
  • 26X more for substance abuse
86
Q

What are physicians required to do in mn in regard to child abuse?

A

Report it, not diagnosis

87
Q

When are you required to report child abuse?

A

When suspected

88
Q

What is child abuse an expression of?

A

Family pathology

89
Q

What percent of abused children become violent adults?

A

33%

90
Q

What are the gender differences of child abuse?

A

Women - physical (54%)

Men - sexual (75%)

91
Q

When does child physical abuse occur?

A

Usually at a younger age than sexual abuse

92
Q

What are bruises on padded areas considered?

A

Inflicted injuries until proven otherwise

Bruises over bony prominences are not bad

93
Q

What are the behaviors of children who are abused?

A

Extreme

Aggressive or withdrawn

94
Q

What can be evidence of inflicted injuries?

A

Burns, bruises, welts, fractures, lacerations, and failure to thrive

95
Q

When does child sexual abuse usually occur?

A

5-7
Usually ending at 13
At every socio economical level

96
Q

What is true of sexually abused children?

A

They believe they caused the abuse
Poor self esteem
They learn to separate from their emotions to cope

97
Q

What is the epidemiology of sexual child abuse?

A

1/4 females
1/7 males
Before 18

98
Q

What is Diathesis?

A

Genetic substrate + huge environmental component

99
Q

What is key of conduct disorder?

A

Lacks empathy

100
Q

What are behaviors of conduct disorder?

A
  • aggression toward animals and people
  • destruction of property
  • theft or deceit fullness
  • serious violation of rules

Presence of 3 or more in the past 12months, 1 in 6months. Usually before 13

101
Q

What is the gender differences in CD?

A
  • 9-10% in boys, 3-4 in girls
  • male predom in adolescence
  • closer by age 15
  • less outward in girls
  • indirect aggression is more common in girls
102
Q

Who was Malala Yusufzai?

A

given CD but organized women to stand up against Taliban

Diagnosis depends on the situation, some may be trying to break down injustice

103
Q

What is treatment of CD?

A

Multi systemic family therapy (MST)

  • home based model
  • low case load, available 24/7
  • understand
  • ## build on strengths
104
Q

What is the criteria for Oppositional Defiant Disorder? (ODD)

A

Negative and hostile behavior lasting at least 6 months with at least 4 of the following present

1: temper
2: argues with adults
3: defies
4: annoy on purpose
5: blames others
6: angry and resentful
7: touchy
8: spiteful

105
Q

What disorders must be ruled out for behavior related aggression?

A

1st: Antisocial personality disorder (if above 18)
2nd: CD
3rd: ODD

106
Q

What % of children with ODD go on to have CD and to ASPD?

A

25% to CD

25-40% to ASPD

107
Q

How do you treat ODD?

A

Under 12 - parents
Positive parenting program - population based intervention
Problem-solving communication training - identify and rank family disagreement and solve one per session

108
Q

What does effective parenting of ODD look like?

A

Early!

  • attention and praise with short commands
  • ignore bad behavior
  • do tokens for compliance (6-8 remove for bad)
  • early is good because progression is costly
109
Q

What are criteria for substance related disorders in adolescents?

A
  1. Recurrent substance result in failure in life
  2. Use in hazardous situations
  3. Legal problems
  4. Continued use despite having problems
    - 2-3 of these in a 12 month period
110
Q

What is are the three leading causes of adolescent mortality associated with substance abuse?

A

Motor vehicle accidents
Homicide
Suicide

111
Q

What is the percent of alcohol and smoking by 18yrs?

A

80% have drank
33% have smoked
50% used an illegal drug

112
Q

What is CRAFTT?

A

Assesses SUD especially with young people

  • Car
  • Relax
  • Alone
  • family/friends
  • Forget
  • Trouble
113
Q

What are some comorbidities of SUD?

A
  • CD precedes 50-80%
  • ADHD in SUD and CD
  • mood disorders (depression)
114
Q

What is the treatment of SUD?

A

MST
CBT
Motivational interviewing (MI)
MEP

115
Q

8.9mil adults had mental illness and SUD, what percentage did not receive treatment?

A

55.8%

32.9% received mental health
Only 3.8% for SUD

116
Q

What is a risk factor for mental illness?

A

Drug abuse - alters the brain as a result of chronic use

117
Q

What NT is high in schizophrenia and how is this pertinent to drug abuse?

A
  • dopamine, drugs increase this

80% of schizophrenics use tobacco –> regulate DA

118
Q

What behavior does ketamine increase?

A

Antisocial behavior

119
Q

What do SUDs increase the risk for in adolescents?

A

Development of psychiatric disorders

However it also goes the other way

Also genetic and environmental factors

120
Q

How do you treat comorbid Pxs of SUD and psychiatric disorders?

A

At the same time.

But you can delay treatment 4weeks to determine the cause, which came first

121
Q

What is sertraline used for?

A

Psychotherapy

However, doesn’t work with methadone but does for depression

122
Q

Why in studies is there such a high improvement of depression with placebo in substance abuse Pxs?

A

Because substance may have caused depression

123
Q

What percent of schizophrenics have SUD?

A

50%

124
Q

What is the treatment of schizophrenia and SUD?

A
  • DA antagonists: haloperidol, fluphenazine
  • 5HT/DA receptor antagonists: Clozaril
  • naltrexone: in EtOH dependance and schizophrenia
125
Q

How can you treat anxiety disorders?

A

SSRIs without SUD

126
Q

What can Buspirone be used for?

A

GAD/alcoholism

Use B for AA (anxiety and alcoholism)

127
Q

What can paroxetine be used for?

A

Social phobia/alcoholism

128
Q

What can sertraline be used for?

A

PTSD and alcoholism

129
Q

What are the criteria for MDD?

A

5 or more symptoms persistent for 2 weeks

  • persistent sadness
  • loss of interest
  • weight changes
  • sleeping problems
  • agitation
  • no energy
130
Q

What is persistent depressive disorder?

A

Depressed mood for at least 2 years (1 in children)

Plus others: over/under eating, low energy…

131
Q

What are bipolar 1 and 2?

A

1: mania 7days
2: hypo mania 4 days

132
Q

What is disruptive mood deregulation disorder?

A
  • intent to distinguish children with mild mood dys regulation from bipolar
  • most do not develop bipolar
  • ## may develop anxiety or depression as adults
133
Q

What are criteria of DMDD?

A

Onset before 10 restricted to 6-18

  • temper outbursts recurrent
  • temper outburst inconsistent with age
  • temper outburst 3 times a week
  • mood between outburst persistently irritable or angry
134
Q

What is the epidemiology of adolescent depression?

A

5% ages 9-17

3% for dysthymia

135
Q

What are some comorbidities for adolescent depression?

A

Eating disorder in girls
ADHD
Cd

136
Q

What meds should be used for treatment of adolescent depression?

A

For severe use SSRIs
TCAs should not be used
Be maintained for a year, if on add or ADHD watch closely

137
Q

What are non med therapies for adolescent depression?

A

CBT - identify negative feelings and link the, with outside world

138
Q

What drugs are best and worse for suicide in adolescents?

A

Prozac is best (fluoxetine)

Effexor is worst (Venlafaxine)

139
Q

What is the black box warning on depression meds for adolescents?

A

May increase suicide chance

140
Q

How often do you watch kids on anti depressants?

A
  • First weekly follow up for 4 weeks
  • then biweekly for a month
  • then quarterly
141
Q

What are common side effects of SSRIs?

A 
Restlessness
Dizziness
Drowsiness
GI distress
HA 
Tremor
142
Q

What are finding of TADS?

A

Combined treatment accelerates benefits

  • at 12 weeks: 71% both, 43% CBT, 61% Prozac.
  • Treating Pxs longer makes a big diff (6month)
  • fluoxetine leads to sx lessening
143
Q

How do you interview for suicide?

A

Be direct, available, interested. Listen
No judgement or shock
Don’t reassure
Don’t be secret

144
Q

What percent of adolescent mothers get PPD?

A

56% for up to 4 years

Higher than if they waited until 20

145
Q

What is the DSM-5 definition of personality disorders?

A
  • enduring meal adaptive patterns of behavior
  • deviating markedly from those accepted by culture
  • patterns develop early and are inflexible and are associated with significant distress or disability
146
Q

What is Baldes definition of a personality disorder?

A
  • people problems
  • no personality with others around
  • dimensional personality problems not categorical contradicts DSM-5
  • imagine what it’s like to be that person
147
Q

What are the three clusters of personality disorders?

A

Cluster A - weird
Cluster B - wild
Cluster C - worried

148
Q

What disorders are in cluster A?

A

Weird - largely heritable
1. Paranoid: threat detector is over active
Distrust, early adulthood, suspects, unjustified doubts, unwarranted fear, bears grudges,
2. Schizoid: basement boys, not psychotic just disconnected from reality, detachment, coldness, no interest in sex
3. Schizotypal: mild schizophrenia, social and interpersonal deficits, distortions, eccentricities of behavior, early adulthood, ideas of reference, odd beliefs, magical thinking, social anxiety

149
Q

What are wild personality disorders?

A 
50/50 causes
Borderline
Narcissistic
Antisocial
Histrionic
150
Q

What is borderline personality disorder?

A

Best chance to intervene positively

  • women > men
  • instability of interpersonal relationships, self image
  • avoid real or imagined abandonment
  • unstable relationships
  • suicidal or self mutilating behavior
  • feelings of emptiness
  • inappropriate intense anger
  • stress related paranoid ideation
  • dialectical behavioral therapy: works, individual therapist, emotional skill management
  • I hate you, don’t leave me. Makes sense to them
151
Q

What can cause antisocial PD?

A

Abused as a child

152
Q

What is antisocial PD?

A
  • disregard for and violation of the rights of others
  • no social norms
  • deceit fullness
  • impulsivity
  • aggressiveness
  • reckless disregard for safety
  • irresponsibility
  • lack of remorse
153
Q

What is Histrionic PD?

A
  • a pervasive pattern of excessive emotionally and attention seeking
  • center of attention
  • sexually seductive
  • emotionally shallow
  • self dramatize
  • is suggest able
  • consider relationships to be more intimate than they are
154
Q

What are worried PDs?

A

Heritable but developmental environment is key

155
Q

What is avoidant PD?

A
  • the world is dangerous respond by internalizing
  • hypersensitive, inadequacy, social inhibition
  • unwilling to get involved with people
  • mostly is a view of self disorder not disinterest
  • psychotherapy can help
156
Q

What is dependent PD?

A
  • needy
  • submissive, clingy, follower
  • uncomfortable or alone
157
Q

What is obsessive compulsive PD?

A
  • perfectionism
  • control
  • unable to complete a project
  • inflexible
  • reluctant to delegate
  • unable to disregard worn out items
  • rigidity or stubbornness
158
Q

What is the natural history of BPD?

A

Mania: 1wk - 6mo

Major depression: 4wks - 2yrs

159
Q

What protein has been implicated in BPD?

A

BDNF - a neuropeptide

Val66Met polymorphism

160
Q

What are some brain abnormalities of BPD?

A
  • low inferior frontal cortex and Ventrolateral prefrontal cortex
  • limbic hyperactivity
161
Q

What meds are proven to have anti suicidal effects?

A

Clozapine and lithium

162
Q

What is activation syndrome?

A

Side effect of SSRIs or hypo mania

- agitated

163
Q

What are the three mood stabilizers?

A

Lithium carbonate
Divalproex sodium
Carbamazepine

164
Q

What are the three primary algorithms of BPD treatment?

A
  1. Tx of acute mania: mono therapy with lithium perhaps dual, later clozapine
  2. Tx of acute/chronic depression: lamotrigine–> quetiapine–> antidepressants
  3. Maintenance: lithium
165
Q

What is key of BPD tx in children?

A

No controlled studies

Lithium –> dual –> tri –> combination

166
Q

What is Ross Greens’s approach to behavior used for?

A

Emotionally labile children

167
Q

What is the concordance of schizophrenia?

A

50% between monozygotic twins

168
Q

What are some candidate genes for schizophrenia?

A

Dysbindin - glutamate and mem stab
Neuregulin-1 - migration, glial diff, myelin
COMT - monoamine metab

169
Q

What infection is schizophrenia most related?

A

Influenze during second trimester

SBM block 2 (1 decks)

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